Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods

Abstract

BackgroundLocal health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions.DesignAlthough the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project.ResultsAll five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans.ConclusionsIn the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.

Improving child survival through a district management strengthening and community empowerment intervention: early implementation experiences from Uganda

“…The surveys focused on availability of essential healthcare inputs; healthcare seeking behavior, coverage and quality of high impact interventions or practices at both community and health facility levels. The LQAS was also used to classify Supervision Areas as high or low performing relative to four predetermined standards set in consultation with program managers [ 21 ]. The data were then aggregated at district level and presented in the form of percentages with regard to coverage of interventions.…”

“…The causal analysis tool enabled DHMTs to determine areas needing management capacity-building and to reprioritize schedules for supervisory visits guided by the performance of the different supervision areas. Possible solutions and strategies were then identified and incorporated into the district annual health work plans with more resources being targeted to low performing Supervision Areas of the district [ 21 ].…”

Does the Narrative About the Use of Evidence in Priority Setting Vary Across Health Programs Within the Health Sector: A Case Study of 6 Programs in a Low-Income National Healthcare System

“…However, this may also be a true reflection of the shortcomings in resources, infrastructure, and personnel capacity at the subnational level-which need to be addressed. 16,17,43 The factors that compete and sometimes trump the use of evidence when setting healthcare priorities have been documented in the literature. Some of the literature alludes to the perceptions that factors such as politics, popularity; may, in some cases, be perceived as more critical -at least to the decision-makers -than what the evidence says.…”

“…In many cases the accountability should be supported with evidence and the funding agencies support the gathering of this evidence. 16,17,[30][31][32][55][56][57][58] As discussed above, it would be efficient for the health system to leverage the resources and the health information structure set up for the funded programs to benefit the less well-funded. Furthermore, respondents from programs such as HIV and Vaccines-seemed more appreciative for qualitative information-which might be a reflection of their experiences with the various types of evidence.…”

Integrated Health Post for Child Health (Posyandu) As A Community-Based Program in Indonesia: An Exploratory Study

“…Aiming to bring health service closer to the community, in many developing countries, community-based health service or program has been implemented. While evidence shows various level of success, community-based program is shown as a potential strategy to improve child health status (Boone, et al, 2017;Borrow, Munns, & Henderson, 2011;Cofie, et al, 2014;Gilmore & McAuliffe, 2013;Macinko, et al, 2007;Nkonki, Tugendhaft, & Hofman, 2017;Odaga et al, 2016;Setiawan, Dignam, Waters, & Dawson, 2016). In Indonesia, the integrated health post for maternal and child health (posyandu) has been nationally endorsed since 1984, as a community-based health program implemented at village level.…”